MEDICARE: DR. JEFFREY MILTON YOUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A34567	CA
2	207P00000X	Emergency Medicine Physician	6126	NV
3	207P00000X	Emergency Medicine Physician	MD2006-0062	NM
4	207P00000X	Emergency Medicine Physician	MD13719	HI

General Provider Information

NPI Number	:	1720072333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY MILTON YOUNG M.D.

Provider Business Mailing Address
First Line	:	1659 SENTIERO DELLA VILLA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-4502
Country	:	US
Telephone Number	:	505-920-0488
Fax Number	:	858-832-8163

Provider Business Practice Location Address
First Line	:	360 S LOLA LN
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-0884
Country	:	US
Telephone Number	:	775-751-7561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	11/15/2009

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